Care Navigator

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Care Navigator based in United States. As a Care Navigator, you will help members navigate the complexities of US health insurance and access the care and coverage they need with greater confidence. You will serve as a trusted point of contact for billing questions, denied claims, coverage concerns, and appeals. Working closely with members, healthcare providers, insurers, and internal teams, you will coordinate administrative processes and help resolve issues from start to finish. You will also guide members toward high-value, in-network care and clarify their benefits in simple, accessible language. By identifying recurring issues in claims and healthcare costs, you will contribute to improving insurance products and the overall member experience. This fully remote role is ideal for a detail-oriented, empathetic professional who enjoys solving complex problems and making healthcare easier to navigate. Accountabilities: In this role, you will help members understand their health insurance coverage, resolve administrative challenges, and access appropriate in-network care. You will combine strong coordination skills with persistence, clear communication, and attention to detail. - Serve as a warm, reliable point of contact for members facing confusing medical bills, denied claims, coverage questions, or other complex insurance issues. - Guide members through the appeals process, helping them understand their options and reviewing complex cases when needed. - Review Explanation of Benefits (EOB) statements to identify potential errors and advocate for members when discrepancies arise. - Coordinate with members and healthcare providers to resolve billing and coverage issues from initial inquiry through final resolution. - Explain prior authorization requirements to members and providers, ensuring submissions are accurate and completed on time, including specialty care and pharmacy pre-authorizations.

- Translate insurance plan structures, coverage rules, and benefits into clear, practical explanations. - Help members identify high-value, in-network providers and care options, focusing on administrative navigation rather than clinical advice. - Identify recurring patterns in claims, billing issues, and healthcare costs, sharing insights that can support improvements to the insurance plan and member experience. Requirements: The ideal candidate brings hands-on experience in medical administration, patient coordination, or health insurance operations, along with the ability to navigate complex billing and claims processes. You should be empathetic, resourceful, and comfortable following up with multiple stakeholders until an issue is resolved. - Several years of experience in a medical-administrative, patient-facing, or healthcare coordination role. - Practical experience with medical claims, billing, and prior authorizations. - Ability to interpret EOB statements, identify potential billing or coverage errors, and determine when further investigation is needed. - Working knowledge of CPT and ICD coding, including how medical charges are structured and submitted. - Experience coordinating between patients or members, healthcare providers, and insurance payers. - Strong follow-through and problem-solving skills, with the persistence to manage cases through to resolution. - Excellent communication skills and the ability to explain complex insurance information clearly and compassionately. - Intellectual curiosity, creativity, independent thinking, adaptability, and a willingness to test new approaches. - Strong integrity and a commitment to doing the right thing for members. - A genuine interest in building a more accessible, global social safety net.